Provider Demographics
NPI:1578572061
Name:DICKENSHEETS, DAVID LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LESTER
Last Name:DICKENSHEETS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4943
Mailing Address - Country:US
Mailing Address - Phone:770-255-1069
Mailing Address - Fax:770-255-1075
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-255-1069
Practice Address - Fax:770-255-1075
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045769207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000803602CMedicaid
GA11SCDRHMedicare ID - Type Unspecified
GA000803602CMedicaid